MRI about to fold?

20. April 2007

For 25 years, magnetic resonance imaging is used without causing any damage to the health. More than 500 million patients were pushed through the tube all over Europe. But the tube might get clogged up. The triggers: Eurocrats.

In 1814, Charles Joseph Fürst von Ligne wrote a letter in Vienna to Talleyrand: “The congress is dancing, but it does not make progress”. This sentence is written large in history. And perhaps it applies again to this year's congress of the European Society of Radiology (ESR) in Vienna. The congress representatives passed a last minute “Alliance for MRI” requiring an exemption clause for use of Magnetic Resonance Imaging (MRI) respectively a delay for a guideline, which is to become national law by April 2008 according to the EU. The reason for the protest: The directive to protect employees from unnecessary exposure to electromagnetic fields leads to physicians and assistants not being allowed to stay during a MRI. This makes it impossible to attend to children, old and handicapped patients as well as anesthetized persons, i. e. in particular to those patients needing personal attention and support, says the president of the ESR. In addition, the set of regulations will significantly impair research and surgery using the imaging system.

The EU-Commission does not take radiologists seriously

The demands of the ESR published at a moderately attended press conference in Vienna, might come too late. Why? When taking a look behind the scene, the observer will find a textbook example of a European burlesque in bureaucracy. Actually, the radiologists could have revisited the topic long before 2004. Because in 2004, the European parliament and council has passed, what was cooking long before in the “Brussels' cubbyholes” behind closed doors under the aegis of the European commission for employment, social affairs and equal opportunities: Minimum regulations to protect the safety and health of employees from hazards caused by physical exposures (electromagnetic fields). The controversial guideline 2004/40/EG was part of an entire flood of EU-regulations supposed to protect working people from health damaging noise, vibrations and other impacts such as cell phone rays etc. But why was this petition not addressed earlier? As we learned from Professor David Norris, Nymwegen, a lobbyist on the side of the protesting radiologists, there were several interventions beforehand. But the EU did not take the objections serious.

The Federal Ministry of Health puts it off

Up to now, the “Alliance for MRI” started in Vienna, was supported by 20 members of the European Parliament, 8 patients' associations and 4 scientific organizations. But no trace of any relevant German engagement is found so far. Not a single representative of the national health ministries is in sight. Obviously it is difficult to achieve consensus on a trans-European level. David Norris confirms that. “Some countries, like the UK, Austria, Finland and the Netherlands, have realized the danger in the EU guidelines very early. Others did not even bother to answer, despite repeated inquiries”. DocCheck interrogated at the press office of the Federal Ministry of Health in Germany, whether the danger of the MRI caused by the Brussels directives are known. The answer: “In my opinion, this is about occupational safety and health. The BMAS is in charge of that. Please get in touch with them”.

Marginal values proven to be save for the patients

After all, two general directors of the relevant European commissions answered to the petition of the “Alliance for MRI”. Is there a gleam of hope? Not really, says David Norris. The text just repeats known positions of the commissions. In order to really stop the directive, he thinks, that the European Parliament and the Council would have to actually agree. And that is no issue at the time being. As time goes by, it is getting more likely, that the first member states will start execution. A stop seems to be unlikely, assumes the radiologist. It's annoying, because there are usable marginal values for exposition as for example from the International Electrotechnical Commission (IEC), applied to protect the MRI patient, proven to be sufficient. According to his present knowledge, no health damaging side effects were registered during more than 100 million MR examinations. There is hardly anything heard of German origin regarding this issue. Do they ignore this problem? DocCheck wanted to have an answer and talked to the head of the radiology department at the University Hospital in Cologne. The planned EU law would be a disaster, says Dr. Axel Goßmann. He considers it a law made nonsensically and completely losing track of reality. “It just simply cannot be, that a law prohibits us to take an MRI on a paraplegic person or on a patient with a tumor in his spine”.

What now? Just carry on as usual?

And what will happen now? The personal opinion of the man in Nymwegen: “I suspect that we will all carry on as before and see if anyone tries to stop us. It will however create an exceedingly difficult legal situation as trade unions may instruct their employees not to exceed the exposure limits, and less expert employees may wonder why they are being expected to take such risks. Hospital managers may also feel that they have to close down their MR facilities in order to avoid the risk of prosecution. In short this will be an unmitigated disaster for the EU which will make all previous controversies surrounding EU legislation seem like nothing.”